Identifying barriers to early diagnosis of breast cancer and perception of women in Malwa region of Punjab,India

Objective:The aim of present study is to identify the breast cancer screening barriers among the women with breast cancer of Malwa region of Punjab,India.The study was conducted at three government hospitals representing almost all districts of Malwa region.Methods:The quantitative research design was followed using empirical research methods.Study was carried out by one-to-one interview by the field investigator and research assistant.Total of 363 breast cancer patient has been interviewed through the scheduled questionnaire and results has been recorded for further analysis.In this study,five barriers are described namely as personal barriers,socio-cultural barriers,economic barriers,health­system barriers,and treatment barriers which contains various questions regarding barriers to breast cancer screening.Univariate analysis methods have been used for the analysis to access the socio-demographic profile of women.Data has been obtained with the help of 5-point liker scale.Binary logistic model was chosen.Results:Majority of participants were in the age groups 50-<60 years(3&6%,140/363)and>60 years(31.1%,112/363).Majority of these women(47.4%,171/363)were illiterate and most of them were housewives.The major barriers to breast cancer screening faced by most of the women were having no knowledge about screening services(90.9%,329/363),the importance of early diagnosis(90.9%,329/363),different screening methods(95.5%,347/363)and place of availing screening services(91.2%,330/363)misguided belief in God and fate(81.5%,295/363)and preferring duties than taking care of health(70.2%,254/363).Education qualification(odds ratio[OR]0.74,β'=-0.309,t=-5.357,P=0.000)and socioeconomic class(OR 1.43,β’=0.354,t=3.399,P=0.001)were found to be significant determinant of the barriers among women.Conclusion:The survey was conducted in the women between the age 40-60 years and as an outcome,the unawareness about screening services,fatalistic attitude,fear of being diagnosed with the cancer,low per capita income was found out significant factors that restricted the women for early check-up for the breast cancer.

Signs and syndromes in acute appendicitis:A pathophysiologic approach

Physical examination signs have not been well studied,and their accuracy and reliability in diagnosis remain unknown.The few studies available are limited in that the method of performing the sign was not stated,the technique used was not standardized,and the position of the appendix was not correlated with imaging or surgical findings.Some appendiceal signs were written in a non-English language and may not have been appropriately translated(e.g.,Blumberg-Shchetkin and Rovsing).In other cases,the sign described differs from the original report(e.g.,Rovsing,Blumberg-Shchetkin,and Cope sign,Murphy syndrome).Because of these studies limitations,gaps remain regarding the signs’utility in the bedside diagnosis of acute appendicitis.Based on the few studies available with these limitations in mind,the results suggest that a positive test is more likely to be found in acute appendicitis.However,a negative test does not exclude the diagnosis.Hence,these tests increase the likelihood of ruling in acute appendicitis when positive but are less helpful in ruling out disease when negative.Knowledge about the correct method of performing the sign may be a valuable adjunct to the surgeon in further increasing their pretest probability of disease.Furthermore,it may allow surgeons to study these signs further to better understand their role in clinical practice.In the interim,these signs should continue to be used as a tool to supplement the clinical diagnosis.

17例耳硬化症患者的临床与影像学分析

目的分析17例耳硬化症患者的临床特征、影像学表现及手术治疗效果。方法收集2020年5月~2023年5月在湖州市中心医院接受手术治疗的17例(17耳)耳硬化症患者临床、影像学资料,分析其临床表现、颞骨CT影像学表现及手术前后纯音测听结果变化。结果17例(17耳)患者中,11耳(64.71%)为前庭窗型,表现为进行性传导性听力损失,其中9耳有耳鸣,3耳有轻微平衡问题;混合型6耳(35.29%)显示混合性听力损失,5耳有耳鸣,3耳有偶发性平衡障碍。影像学上,前庭窗型显示镫骨底板区域骨质增厚、前庭窗密度增加;混合型则显示镫骨底板增厚及耳蜗周围密度减低,1耳可见“双环征”,两种类型耳硬化症患者骨密度差异无统计学意义(P>0.05)。术后均未见耳鸣加重或其他严重并发症,仅2例(11.76%)出现暂时性头晕,术后随访显示术区恢复良好,无感染或其他迟发性并发症;术后听力测试显示气导阈值、气骨导差较术前显著改善(P均<0.05)。结论前庭窗型和混合型耳硬化症的影像学和临床表现各有特点,镫骨成形术可显著改善听力,降低气导阈值和气骨导差,且手术安全、并发症少。

Routine diagnosis of intestinal tuberculosis and Crohn's disease in Southern India

AIM:To investigate whether routinely measured clinical variables could aid in differentiating intestinal tuberculosis(ITB)from Crohn’s disease(CD).METHODS:ITB and CD patients were prospectively included at four South Indian medical centres from October 2009 to July 2012.Routine investigations included case history,physical examination,blood biochemistry,ileocolonoscopy and histopathological examination of biopsies.Patients were followed-up after 2 and 6 mo of treatment.The diagnosis of ITB or CD was re-evaluated after 2 mo of antituberculous chemotherapy or immune suppressive therapy respectively,based on improvement in signs,symptoms and laboratory variables.This study was considered to be an exploratory analysis.Clinical,endoscopic and histopathological features recorded at the time of inclusion were subject to univariate analyses.Disease variables with sufficient number of recordings and P<0.05 were entered into logistic regression models,adjusted for known confounders.Finally,we calculated the odds ratios with respective confidence intervals for variables associated with either ITB or CD.RESULTS:This study included 38 ITB and 37 CD patients.Overall,ITB patients had the lowest body mass index(19.6 vs 22.7,P=0.01)and more commonly reported weight loss(73%vs 38%,P<0.01),watery diarrhoea(64%vs 33%,P=0.01)and rural domicile(58%vs 35%,P<0.05).Endoscopy typically showed mucosal nodularity(17/31 vs 2/37,P<0.01)and histopathology more frequently showed granulomas(10/30vs 2/35,P<0.01).The CD patients more frequently reported malaise(87%vs 64%,P=0.03),nausea(84%vs 56%,P=0.01),pain in the right lower abdominal quadrant on examination(90%vs 54%,P<0.01)and urban domicile(65%vs 42%,P<0.05).In CD,endoscopy typically showed involvement of multiple intestinal segments(27/37 vs 9/31,P<0.01).Using logistic regression analysis we found weight loss and nodularity of the mucosa were independently associated with ITB,with adjusted odds ratios of 8.6(95%CI:2.1-35.6)and 18.9(95%CI:3.5-102.8)respectively.Right lower abdominal quadrant pain on examination and involvement of≥3 intestinal segments were independently associated with CD with adjusted odds ratios of 10.1(95%CI:2.0-51.3)and 5.9(95%CI:1.7-20.6),respectively.CONCLUSION:Weight loss and mucosal nodularity were associated with ITB.Abdominal pain and excessive intestinal involvement were associated with CD.ITB and CD were equally common.

Symptom distress and interference among cancer patients with osteoradionecrosis of jaw: A cross-sectional study

Objective:Osteoradionecrosis of the jaws(ORNJ)is among the most serious oral complications of head and neck cancer treatment with radiation therapy.This study aimed to examine the level of symptom distress and interference of ORNJ in head and neck cancer patients in China.Methods:A cross-sectional study was conducted to profile patient reported symptom severity.Ninetyfive hospitalized ORNJ patients were recruited.Participants completed the MD Anderson Symptom Inventory-Head and Neck Module-Chinese version.Results:The percentage of participants who reported that they experienced at least one type of symptom was 97.9%,and 85.2%patients reported interference.The 10 most severe symptoms were as follows:limited mouth opening,problem with teeth/gums,difficulty swallowing/chewing,dry mouth,oral malodor,difficulty with voice/speech,dental ulcer,tinnitus/ear obstruction,skin pain/burning/rash,and difficulty hearing.The problem of limited mouth opening was more severe in patients with longer time to onset of ORNJ after radiotherapy.The interference of patients positively correlated with core symptoms(r=0.612),head and neck symptoms(r=0.709),and ORNJ symptoms(r=0.440)(P<0.01).The longer time to the onset of ORNJ after radiotherapy was positively and significantly correlated with symptom distress(r=0.479,P<0.001),and mouth opening correlated negatively with symptom distress(r=-0.298,P=0.003).Conclusions:ORNJ patients suffered mainly from limited mouth opening and other maxillofacial symptoms.The problem of limited mouth opening was more severe in patients with longer time to onset of ORNJ after radiotherapy.ORNJ patients commonly had symptom distress,which influenced their quality of life.

Sheehan’s syndrome and anterior hypopituitarism

A case of Sheehan’s syndrome and anterior hypopituitarism was collected in Geriatric department of the third clinical college of Inner Mongolia medical university.Due to atypical clinical symptoms,it is easy to be delayed in its diagnosis and treatment.The paper aims to investigate the difference of clinical characteristics and treatment outcome of anterior hypopituitarism through case analysis.

Effectiveness and safety of Jinshuibao capsules(金水宝胶囊)in treatment of residual cardiopulmonary symptoms in convalescent patients of coronavirus disease 2019:a pilot randomized,double-blind,placebo-controlled clinical trial

OBJECTIVE:To evaluate the effectiveness and safety of Jinshuibao capsules(金水宝胶囊),a Traditional Chinese Medicine(TCM),in the treatment of residual cardiopulmonary symptoms in convalescent corona virus disease 2019(COVID-19)patients.METHODS:A total of 200 participants with COVID-19 in convalescence phase were randomly assigned into two groups at a 1:1 ratio in this multicenter randomized,double-blind,placebo-controlled trial.One group received Jinshuibao capsules,and the other received placebo.The patients were followed up at one and two weeks of treatment.Five symptoms(dry cough,shortness of breath,sweating,chest tightness and palpitation)improvement rates and full recovery rates were compared.RESULTS:All baseline characteristics were comparable between the two groups.After two weeks of treatment,symptom improvement rates for dry cough(74.00%vs 50.00%,P=0.015),shortness of breath(78.95%vs 46.15%,P<0.001),sweating(80.00%vs 57.75%,P=0.004),chest tightness(87.06%vs 60.47%,P<0.001)and palpitation(82.50%vs 64.56%,P=0.010)were significantly higher in the Jinshuibao group compared with the control group.Meanwhile,Jinshuibao capsules treatment also displayed more satisfactory full recovery rates of all five symptoms(dry cough 58.00%vs 19.57%,shortness of breath 18.95%vs 7.69%,sweating 36.00%vs 19.72%,chest tightness 32.94%vs 13.95%,and palpitation 48.75%vs 29.11%)in participants with COVID-19 in convalescence phase compared with the control group(P<0.05).No severe adverse events were reported in either group.CONCLUSIONS:Jinshuibao capsules have the potential to improve residual cardiopulmonary symptoms in convalescent COVID-19 patients,with few adverse events.

Symptom trajectories in patients with breast cancer:An integrative review

Objective This study aimed to synthesize the available knowledge of symptom trajectories in patients with breast cancer and identify predictors associated with these trajectories.Methods Whittemore and Knafl’s integrative review method was employed to guide a systematic search for literature in four databases(PubMed,Embase,Web of Science,and CINAHL).The retrieved articles’publication time was limited to 2010 to 2020,and only peer-reviewed English articles were included.Results Twenty-seven articles were included.The findings of the relevant studies were analyzed using thematic analysis.They were grouped into two themes:symptom trajectories of patients with breast cancer(symptom trajectories in patients with breast cancer,in patients who underwent surgery,and in patients who received cancer-related treatment)and associated factors(socioeconomic factors,health characteristics,cancer-related treatment characteristics).Newly diagnosed patients tended to report high trajectories of depression and persistent sleep disturbance.Most patients who underwent surgery reported significant sleep disturbance and anxiety shortly after surgery.For patients who received cancer-related treatment,only a small proportion had a high level of physical activity after cancer-related therapy over time.A high body mass index,a low relationship quality,parental responsibilities,insufficient social support,a low educational background,and an unhealthy lifestyle may increase the risk of negative symptom trajectories in patients with breast cancer.Additionally,old patients were more likely to report cognitive impairment after chemotherapy,while young patients tended to report trajectories of persistent sexual dysfunction.Concurring symptoms and poor health status also contributed to adverse symptom trajectories.Conclusion The findings of this review add to the body of knowledge of the interindividual variability of symptom trajectories in patients with breast cancer.Despite the overall similarity in appraisal at baseline,the patients reported varied symptom trajectories over time.It is recommended that nurses consider sociodemographic,clinical and cancer-related treatment characteristics and perform targeted early preventive interventions for patients with breast cancer.

Cutaneous lesions and visceral involvement of tuberous sclerosis

Tuberous sclerosis (TS) is an autosomal dominant disorder with a significantrange of clinical expressions. The involvement of vital organs, such as the brain, kidney, heart andlung is the main cause of death in patients with TS. The aim of this study is to summarize thecharateristic cutaneous features and common extracutaneous involvement of TS, which are helpful tothe early detection of visceral involvement. The analyzed clinical data from 78 patients with TSincluded those from detailed history, physical and dermatological examination, cranial computedtomography ( CT) and magnetic resonance imaging ( MRI) , abdominal ultrasonography, chestroentgenography, hand and foot X-ray and ophthalmologic examination. The skin, brain and kidney wereinvolved frequently in TS patients. Hypomelanotic macules were the most common and earliestcutaneous lesions. Their number was more than 3 in 81. 5% of'the patients. They were followed byfacial angiofibromas and Shangreen' s patch in a decreasing frequency. Forehead plaque, facialangiofibromas and Shagreen's patch appeared in patients at mean age of 2. 6, 6. 0 and 8. 1 yearsrespectively. Cranial CT showed a high positive rate in TS patients . Cutaneous features of TS arehelpful in the early diagnosis of the disease. Hypomelanotic macules are especially important forpatients with epilepsy or babies whose number of hypomelanotic malues is more than 3. Cranial CT isof great value in the diagnosis of TS. The involvement of visceral organs such as the brain andkidney should be examined in TS patients.

Symptoms of long-term exposure to moxa smoke in acupuncturists： a correlation analysis

OBJECTIVE: To investigate the effects of long-term exposure to moxa smoke on acupuncturists and to consider the association between physical symptoms and gender, age, secondhand smoke(SHS) exposure, and the duration of exposure.METHODS: A self-report, web-based questionnaire was used to evaluate the effects of moxa smoke onacupuncturists. Logistic regression was used to analyze the relationship between physical symptoms and possible correlative factors.RESULTS: A total of 858 questionnaires were analyzed. The data showed that 42.42% of acupuncturists had been exposed to moxa smoke for 5-10 years. The most frequent symptom was tearing(32.98%) and the least frequent symptom was asthma(5.24%). Logistic regression analysis showed that female acupuncturists were slightly more susceptible to cough and tearing than males(cough:OR: 1.583, 95% CI: 1.079, 2.321, P = 0.019; tearing:OR: 1.519, 95% CI: 1.094, 2.108, P = 0.013). Acupuncturists aged over 25 years reported a slightly lower incidence of eye itchiness than those aged under25 years(26-40 years: OR: 0.604, 95% CI: 0.379,0.965, P = 0.035; over 40 years: OR: 0.330, 95% CI:0.114, 0.958, P = 0.042). Ophthalmodynia occurred less in acupuncturists aged 26-40 years(OR: 0.591,95% CI: 0.359, 0.970, P = 0.038) than in those younger than 25 years. The only association between prevalence of symptoms and tobacco use and SHS exposure was that smokers had a lower occurrence of phlegm in the throat(OR: 0.579, 95% CI: 0.392,0.856, P = 0.006). Shortness of breath was less frequent in participants exposed to moxa smoke for more than 5 years(5-10 years: OR: 0.400, 95% CI:0.204, 0.785, P = 0.008; 11-20 years: OR: 0.392, 95%CI: 0.178, 0.864, P = 0.02), but a slightly higher incidence of eye itchiness was found in those with over20 years of moxa exposure(OR: 4.200, 95% CI:1.344, 3.128, P = 0.014).CONCLUSION: The most frequent symptom of moxa smoke exposure in acupuncturists was tear-ing. The association of symptoms with age and duration of exposure to moxa smoke were rather complicated; hence, care should be taken in drawing conclusions about the safety of moxa smoke based solely on its potentially harmful ingredients.

Campylobacter enteritis in adult patients with acute diarrhea from 2005 to 2009 in Beijing, China

Background There has been a marked global increase in the incidence of human Campylobacter enteritis in recent years. This study investigated the epidemiological and clinical features of Campylobacter enteritis in adult patients suffering from acute diarrhea.Methods This was a retrospective review of Campylobacter enteritis in adult patients with acute diarrhea presenting at Beijing University First Hospital, Beijing, China, in the summer and autumn （April to October） of 2005 to 2009. The data collected included the species of campylobacter identified, and the age, gender, clinical manifestations and results of laboratory test on stool samples collected from the patients. Campylobacter sensitivity tests to various antimicrobial agents were conducted on 80 specimens. Chi-square tests were applied using SPSS13.0 software and a two-sided P value of 〈0.05 was considered statistically significant.Results Campylobacter spp. isolated from the stool specimens of 142 patients with diarrhea represented 14.9% of all the cases examined. C. jejuni was identified in 127 patients （89.4%） and C. coli in 15 others （10.6%）. The infection incidence was highest in the age range of 21-30 years which comprised 21.7% of the total cases examined. Most cases of diarrhea （46 patients） occurred in June. Watery diarrhea （97.2%）, abdominal pain （72.5%） and fever （64.8%） were the most common manifestations of enteric campylobacteriosis. Only four patients （2.8%） had bloody diarrhea. The antimicrobial resistance rates were： cefoperazone （100%）, levofloxacin （61.3%）, gentamicin （12.5%）, erythromycin （6.3%）, and azithromycin （2.5%）.Conclusions Campylobacter was prevalent among adults with acute diarrhea from 2005 to 2009 in Beijing, China. The large number of those afflicted by the disease warrants the commission of a large multicenter study to determine the extent of enteric campylobacteriosis in this region

Heel pain： A systematic review

Heel pain is a very common foot disease. Varieties of names such as plantar fasciitis, jogger＇s heel, tennis heal, policeman＇s heel are used to describe it. Mechanical factors are the most common etiology of heel pain. Common causes of hell pain includes： Plantar Fasciitis, Heel Spur, Sever＇s Disease, Heel bump, Achilles Tendinopathy, Heel neuritis, Heel bursitis. The diagnosis is mostly based on clinical examination. Normally, the location of the pain and the absence of associated symptoms indicating a systemic disease strongly suggest the diagnosis. Several therapies exist including rest, physical therapy, stretching, and change in footwear, arch supports, orthotics, night splints, anti-inflammatory agents, and surgery. Almost all patients respond to conservative nonsurgical therapy. Surgery is the last treatment option if all other treatments had failed. Rest, ice, massage, the use of correct exercise and complying with a doctor＇s advice all play important part in helping to recover from this hell pain condition, but getting good quality, suitable shoes with the appropriate amount of support for the whole foot is the most important.